I’ve got a Mirena, which releases synthetic progesterone. Like Depo-Provera (injectable synthetic progesterone), it can stop your periods altogether. Of course, it can also cause all the unpleasant side effects Depo can cause–weight gain, breakthrough bleeding, irregular periods, mood swings, and dysphoria. Luckily for me, my body likes synthetic progesterone. You might have one of the copper-T models, which are good for twice as long, but often cause heavier periods and increased cramping.
In the money oriented mind of the benefit provider, it could be that they cover Viagra and not birth control pills because less people are on Viagra and it means they pay out less money.
Course it does seem like they should cover birth control pills. My plan here at work covers pills but not the patch, and only covers the generic pills.
I had to fight tooth and nail to get our insurance to cover my IUD (copper-T; no cramping: lucky me!). As smoker, my doc strongly advised against any hormonal therapy, so this was really the only other option.
After much back and forth, insurance company finally agreed to pay, I think, 70% of the cost. The doctor required a pre-approval letter from the insurance company before performing the procedure. We got the letter, paid our portion, and I got the IUD. However, the doc then went through heck trying to get reimbursed by the very same insurance company who sent the letter saying they would cover it. Thankfully, with that letter, he was unable to come after me for it.
What a nightmare! I’ve said it many times before and I’ll say it again. Insurance companies suck (that is, until they pay a hefty medical bill).
tamaraqueenofgoths, I’ll take you at your word that you’re no male basher.
However, I don’t think a lot of people grasp what a debilitating condition impotence is. It essentially takes men with normal sex drives and robs them of the ability to achieve sexual pleasure.
Clitorectomy is a major human rights issue for just this reason. But, when it happens to a man, he becomes a joke somehow. Viagra is a punch line in a million Jay Leno monologues. I cannot, for the life of me, fathom this dichotomy.
Viagra, quite frankly, is a miracle drug. It was discovered by accident, in testing for cardiac medication. Before this, many cases of impotence simply couldn’t be treated at all. Why shouldn’t it be paid for by insurance plans?
BTW, I do favor paying for contraception in health plans.
My insurance covers vaigra. I get six pills a month covered (because in insuranceland, six is the minimum number of nookie sessions needed for good health).
But I do pay $40.00 out of pocket. I get your point, though. Truth be told, I’d of paid double for half as much.
Who am I kidding? I’d of given them one of my legs.
tamara, who manages your prescription benefits? If it’s not too personal, who’s your plan through? I might be able to give you a bit more insight.
SIX?!!? A month?! Dang, you’re gettin’ more than I am! WAAAAY more!
I said I get six pills a month. I didn’t say I *use * six pills a month.
The reason was explained pretty early in the thread, and I think was lost in all the “You’re MALE BASHING” hoo hah afterward:
quoth Daisy Mae:
Most insurances have switched employers to something called “self funded plans.” The employer gets basic benefits plus, depending on how much they have to spend in premiums, a certain number of benefits. THEY decide what’s covered, what isn’t. Also, your copay. Also, your deductible level. If your birth control isn’t covered, it’s because your employer decided it wasn’t cost effective, or they didn’t want to pay for that particular benefit, for whatever reason. I would however, get myself down to my HR office toot sweet and raise holy hell. They can’t change the benefits til next open enrollment, but if enough people complain, you can get them to add it.
In the mean time, I second Eva Luna. Get yourself to PP. They’re wonderful about helping you obtain affordable birth control. And they’re everywhere, pretty much.
Why should the insurance company knowingly take on a certain loss? When your insurers took you on, you didn’t know you were going to need such care, did you? The insurers knew that there was a probability that you might and therefore an Expectation of payout. But they weren’t paying from the start, were they?
Let’s take a more extreme example: would you expect an insurer to take on someone who already requires constant care 24/7 and needs treatment costing millions? The same principle applies.
You need an american here, but I get the impression the thing is medical insurance isn’t just seen as insurance: the government requires certain things to be covered, if insurance comes with a job it may be forced to cover things it wouldn’t normally. Yes, I don’t quite get the system, but I think there is something more to it than just insurance, for which I agree it wouldn’t make sense for certanties to be covered. (Though preventatives would still make sense…)
I’m just so happy the British government decided that BCPs need to be free of charge to all women (in theory it’s to ensure that women with no independent income can receive contraception without notifying their parents or spouses).
BCPs are used in two ways, one as a contraceptive, the other as a treatment. If you are using them as a medication for symptomatic relief, they should be covered by your insurance.
The IUD which reduces bleeding (sometimes to zero) is Mirena, right?
They already do. It goes against their reserve. That’s why it’s called “risk,” or “high risk.” Every insurance company has coverage categories for risk and high risk clients. If what you were saying was the case, no smoker would ever get insurance. Neither would a pregnant woman. Prenatal care ain’t exactly cheap, especially a high risk pregnancy. Those cases are factored in to the actuarials.
Yes. I would. When a patient’s employer or group coverage changes to another insurance, whether that patient needs 24hr care or has a chronic problem, there is still coverage for that patient. It transfers to the new carrier. And the new carrier is required to pay, as long as medical necessity can be proven. Pre-existing condition applies to a problem the patient has had in the past, which is why the 6 month waiting period. This reduces the risk. If the problem resurfaces during the last 3 months of prior coverage, or the first three months of new coverage, it is denied as pre existing until it is deemed chronic. But ongoing problems are treated.
Shade, ERISA guidelines and some state guidelines (such as mine) do require that certain things be covered by insurance carriers; mostly emergency and urgent care. Employers have found a loophole with self funded plans. If there is something they do not agree with, such as paying for experimental drugs or procedures, they simply tell the administrator of the plan (the insurance company) they don’t want to cover it.
Almost forgot, so sorry…
qts, there is something insurance companies factor every month called a PMPM (Per Member, Per Month). It’s an average of how much each member likely to cost the employer/insurance company. They take into account what was spent last quarter/year for that group and averaged into 12 months. Including the catestrophic cases. This gives them a basic idea of how much they can expect to pay out. Same with drug benefit plans. Patients are expected to need prescriptions. This risk is reduced by offsetting with higher copays and generic drugs. Also non formulary drugs are generally covered at a much lower benefit.
I am not male bashing.
Clitorectomy is caused by religious reasons or local customs. There is no medical reason necessary for one. Not that I know of.
Erectile Dysfuntion is caused by the body not working properly.
I know what you mean - no laughing matter - but they are apples and oranges.
And frankly, I never want to see that commerical of the guy getting the football through the tire swing hole ever again. All that is missing from that is fireworks, a parade with flag waving and the man smoking a cigerette in masculine satisfaction afterwards. GAH.
The fact that women have been fighting for years to get BCP covered and have only started to make headway, but this miracle drug Viagara comes along and it is nearly instantaeously approved across the board does not make it an easy pill to swallow for us females. This paragraph contains alot of sexual innuendos. Heh heh.
What I want to know is when is there going to be a legitimate ( not herbal) pill for women who suffer from what ever the female equivalent of erectile dysfuntion is called and how will the insurance companies treat it.
Everyone is focused on the men getting it up. What about the women who have lost their groove and how can they get it back, stella?
Actually, many insurance companies don’t cover Viagra. They consider it an “elective” therapy, or a “lifestyle” drug.
Unless they’ve changed very recently, mine doesn’t cover it.